Existential Distress

Overview

Dying brings decline in health, withdrawal from social networks, loss of normal roles, and the utter aloneness with the confrontation of the end of one’s existence. Existential distress at the end of life has been defined as hopelessness, burden to others, loss of sense of dignity, desire for death or loss of will to live [1] and threats to self identity. [2] Existential Loneliness has entered the literature and 'is understood as an intolerable emptiness, sadness, and longing, that results from the awareness of one’s fundamental separateness as a human being.' [3]

What is known

Empirical studies have named a number of experiences that can be described as patient existential plight or distress. [4-8]

There is significant relationship between cancer patient’s distress and the distress of his or her carer - they experience similar levels of distress. [9-10]

Women report more distress than men regardless of whether they are carers or patients. [10]

What it means for practice

The multidisciplinary team needs to explore within its own organisation the best way to address patients’ existential needs. [11-12] Recent research identifying stress in teams related to existential issues confirms that individual, group, institutional and cultural forces influence individual experience. [12-15]

Active research areas / controversies

How health care professionals can best support existential well being is not known. [2]

The effects of existential distress on physical symptoms are not known. [2]

Screening of distress is still under development and recommendation of which tool to use depends on context of use. [17-18]

Lack of empirical attention to ideas around existential loneliness and psychosocial and spiritual interventions has been suggested as a contributing factor to the unfounded use of deep continuous sedation and even euthanasia. [3]